Healthcare

Solutions: Actuarial System Development for Health Insurer

One of the nation’s leading health insurance companies focuses on delivering the best services to its nearly 15 million customers including group life, disability, dental, and a range of various individual solutions. With an abundance of data in their system, selecting and validating this data for their annual government submission can be extremely challenging. They needed to improve their system code in order to be more timely and efficient.

Purpose

As a health insurance company, they are required to provide an annual government submission regarding premiums and claims. With this, hundreds of millions of dollars in risk transfer payments are at stake. Having billions of records in their database, the process of selecting and validating the data to submit can be extremely arduous and time consuming. With this large amount of unstructured data, they needed a faster way to find, validate and clean it all before submitting to the government.

Process

Solving IT was able to understand the client’s exact pain points and identify an Actuarial Systems Developer with a strong data analysis background. He began by working closely with different business units in order to gather the needed data. Using his strong SQL skills, he was able to re-code their run process as well as reduce the run cycle of queries from 4 days to just a few hours. Having the code in a clean and consolidated format allowed them to identify the necessary code changes, as well as data defects that were impacting the accuracy of the submission data.

Results

With the new system in place, the client was able to reconcile a premium discrepancy of over $20 million, increasing their data accuracy level to an outstanding 99.9%, while ensuring their submission numbers would stand up under any audit.